Association of previous treatment with anti-tumour necrosis factor inhibitors with the effectiveness of secukinumab in the treatment of psoriatic arthritis: systematic review and meta-analysis

Rheumatology ◽  
2020 ◽  
Vol 59 (12) ◽  
pp. 3657-3665
Author(s):  
Yantao Xu ◽  
Yuting Li ◽  
Mengyuan Dong ◽  
Zi’ang Gao ◽  
Xiang Chen ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Meta Analysis ◽  
Previous Treatment ◽  
Cochrane Library ◽  
Acr20 Response ◽  
Naive Group ◽  
American College Of Rheumatology ◽  
History Of ◽  
Effectiveness Data ◽  
Necrosis Factor

Abstract Objectives We sought to systematically investigate the effectiveness of secukinumab in psoriatic arthritis (PsA) patients who previously received TNFs inhibitor (TNFi) treatment and those who were TNFi naïve. Methods Databases (PubMed, EMBase and Cochrane library) and ClinicalTrials.gov were searched from inception to 22 May 2020 for randomized control trails and observational studies of secukinumab, with or without a history of previous anti-TNFi treatment, in PsA. Effectiveness data were extracted and combined using a random-effects meta-analysis. The ACR20 and ACR50 (20% and 50% improvement in American College of Rheumatology response criteria) responses were the endpoints. Results Six randomized controlled trials that reported the effectiveness of secukinumab by previous anti-TNFi treatment were included. Among patients exposed to a prior anti-TNFi treatment (n = 738), 33.7% (249/738) of patients achieved an ACR20 response. In contrast, in the anti-TNFi-naïve group (n = 1754), 49.8% (873/1754) of patients achieved an ACR20 response. Prior treatment with anti-TNFi was significantly associated with a poorer response to secukinumab compared with the anti-TNFi-naïve group with an effect size of 2.09 (95% CI: 1.69, 2.58). Conclusion Some patients benefit from switching from TNFi to secukinumab, but previous anti-TNFi treatment is associated with poorer effectiveness of secukinumab.

Biological Therapy for Psoriatic Arthritis in Clinical Practice: Outcomes Up to 2 Years

2010 ◽  
Vol 37 (11) ◽  
pp. 2362-2368 ◽  
Author(s):  
LIISA M. VIRKKI ◽  
BINDU C. SUMATHIKUTTY ◽  
MERJA AARNIO ◽  
HEIKKI VALLEALA ◽  
RIITTA HEIKKILÄ ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Health Assessment ◽  
Routine Care ◽  
Biological Drugs ◽  
Acr20 Response ◽  
Reactive Protein ◽  
American College Of Rheumatology ◽  
Factor Α ◽  
Assessment Questionnaire ◽  
Necrosis Factor

Objective.To evaluate the performance of biological drugs in psoriatic arthritis (PsA) in a routine care setting, using the Finnish national register of biological treatment (ROB-FIN).Methods.Patients with PsA who started therapy with infliximab or etanercept between June 2000 and February 2006 (n = 127) were followed for up to 24 months. Response was evaluated using American College of Rheumatology response criteria including individual measures.Results.Significantly diminished values for swollen and tender joints, patient’s global and pain assessments, doctor’s global assessment of disease activity, erythrocyte sedimentation rate, C-reactive protein, and Health Assessment Questionnaire score were observed within 3 months after commencement of both infliximab and etanercept. Values remained significantly lower throughout the 24 months of followup. ACR20 response at 3 months was 79% (n = 22/28) for infliximab and 76% (n = 34/45) for etanercept. The first biological drug was discontinued in 16% due to lack of effectiveness and in 6% due to adverse events.Conclusion.Anti-tumor necrosis factor-α therapy, often combined with conventional disease-modifying antirheumatic drugs, appeared to have limited toxicity and persistent effectiveness for up to 2 years in a cohort of Finnish patients with severe peripheral PsA.

scholarly journals OP0214 INCIDENCE OF CANCER (RELAPSE OR NEW ONE) FOLLOWING BDMARDS INITIATION IN PATIENT WITH RHEUMATOID ARTHRITIS AND HISTORY OF CANCER: A SYSTEMATIC REVIEW WITH META-ANALYSIS OF OBSERVATIONAL STUDIES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 133.2-133
Author(s):  
A. Wetzman ◽  
T. Barnetche ◽  
C. Lukas ◽  
C. Gaujoux-Viala ◽  
B. Combe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Meta Analysis ◽  
Tnf Inhibitors ◽  
Cochrane Library ◽  
Risk Of Recurrence ◽  
American College Of Rheumatology ◽  
Skin Cancers ◽  
History Of ◽  
History Of Cancer ◽  
Risk Of Relapse

Background:The tolerance of targeted biologic therapies (bDMARDs) used in rheumatoid arthritis (RA) has been studied in patients with no history of cancer. A 5-year cancer remission is recommended to initiate treatment with bDMARDs. However, in the context of the aging of the population and the increase in screening for neoplasia, the question of targeted treatment in a patient with RA with a history of cancer is usual.Objectives:To determine the risk of recurrence or a new malignancy when exposed to a b-DMARDs in adults with RA and a history of cancer.Methods:A systematic literature search of EMBASE, MEDLINE, Cochrane Library, and electronic abstract databases of the annual scientific meetings of both the European League Against Rheumatism and the American College of Rheumatology was conducted through June 2019 and selected all cohort follow-up studies including adults with RA with a history of cancer and treated with b-DMARDs (TNF inhibitors, rituximab, abatacept and tocilizumab). We compared the risk of relapse or new cancer onset between the groups treated with and without b-DMARDs. The RevMan 5.3 software was used to calculate the cumulative risks from each group’s Hazard Ratio (HR), with their 95% confidence intervals. The heterogeneity of the studies was evaluated by the Cochran Q test and expressed with the I2value.Results:26 observational cohort studies were selected, of which 12 were included in the meta-analysis. The overall risk of new cancer or recurrence of neoplasia in RA patients with a history of cancer, compared to control subjects, for all b-DMARDs combined was 1.09 (p=0.29, 95%CI [0.92-1.32], I2=16%). The risk of relapse or new cancer onset in patients exposed to TNF inhibitors was 1.11 (p=0.45, 95%CI [0.85-1.46], I2=48%) and 0.79 (p=0.49, 95%CI [0.41-1.53], I2=10%) for rituximab. The rate of recurrence was 1.32 (p=0.04, 95%CI [1.02-1.72], I2=0%) for skin cancer, 1.28 (p=0.07, 95%CI [0.98-1.67], I2=0%) for skin cancers excluding melanoma and 1.21 (p=0.31, 95%CI [0.84-1.72], I2=0%) for breast neoplasia.Conclusion:This is the first meta-analysis evaluating the risk of recurrence or new cancers in a RA population with a history of neoplasia exposed to b-DMARD. For patients with a history of cancer, for whom the benefit / risk balance has been found to be favorable, the initiation of b-DMARD treatment for RA does not seem to significantly increase the risk of recurrence or new cancer compared to patients naïve to biological treatments, apart from skin cancers including melanoma.Disclosure of Interests:Amélie Wetzman: None declared, Thomas Barnetche: None declared, Cédric Lukas: None declared, Cecile Gaujoux-Viala: None declared, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Jacques Morel: None declared, Paulina Szafors: None declared

scholarly journals Diagnostic Performance of TE, 2D-SWE And MRE For Liver Fibrosis In Treatment-Naive People With HBV: A Systematic Review And Meta-Analysis

2021 ◽  
Author(s):  
Mingkai Li ◽  
Sizhe Wan ◽  
Xiaoying Wu ◽  
Bin Wu
Keyword(s):  
Diagnostic Accuracy ◽  
Linear Models ◽  
Transient Elastography ◽  
Meta Analysis ◽  
Previous Treatment ◽  
Shear Wave Elastography ◽  
Threshold Effect ◽  
Cochrane Library ◽  
Significant Fibrosis ◽  
Treatment Naïve

Abstract Background/aims: To assess the performance of transient elastography (TE), two-dimensional shear wave elastography (2D-SWE), and magnetic resonance elastography (MRE) for staging significant fibrosis and cirrhosis in untreated chronic hepatitis B (CHB) patients. Methods: Pubmed, Embase, Web of Science and Cochrane Library were searched for terms involving CHB, TE, SWE, and MRE. Other etiologies of chronic liver disease (CLD), previous treatment in patients or articles not published in SCI journals were excluded. Hierarchical non-linear models were used to evaluate the diagnostic accuracy of TE, 2D-SWE and MRE. Heterogeneity was explored via analysis of threshold effect and meta-regression. Results: Twenty-eight articles with a total of 4540 untreated CHB patients were included. The summary AUROC using TE, 2D-SWE and MRE for predicting significant fibrosis (SF) were 0.84, 0.89, and 0.99, respectively. MRE is more accurate than both TE (P＜0.01) and 2D-SWE (P＜0.01) in staging SF. 2D-SWE is superior to TE in detecting SF (P＜0.01). The summary AUROC employing TE, 2D-SWE and MRE for detecting cirrhosis were 0.9, 0.94, and 0.99, respectively. TE displayed a similar diagnostic accuracy with 2D-SWE in staging cirrhosis (P=0.14). MRE and 2D-SWE are comparable for staging cirrhosis (P=0.08). MRE is superior than TE (P＜0.01) in staging cirrhosis.Conclusion: TE, 2D-SWE, and MRE express acceptable diagnostic accuracies in staging staging significant fibrosis and cirrhosis in untreated CHB patients. Both MRE and 2D-SWE are better choices while the TE can be regarded as a secondary option.

scholarly journals Clinical and Imaging Predictors of Recurrent Ischemic Stroke: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 45 (5-6) ◽  
pp. 279-287 ◽  
Author(s):  
Frans Kauw ◽  
Richard A.P. Takx ◽  
Hugo W.A.M. de Jong ◽  
Birgitta K. Velthuis ◽  
L. Jaap Kappelle ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Lower Risk ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Large Artery ◽  
Cortical Lesions ◽  
Level Of Evidence ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
History Of

Background: Predictors of recurrent ischemic stroke are less well known in patients with a recent ischemic stroke than in patients with transient ischemic attack (TIA). We identified clinical and radiological factors for predicting recurrent ischemic stroke in patients with recent ischemic stroke. Methods: A systematic search in PubMed, Embase, Cochrane Library, and CINAHL was performed with the terms “ischemic stroke,” “predictors/determinants,” and “recurrence.” Quality assessment of the articles was performed and the level of evidence was graded for the articles included for the meta-analysis. Pooled risk ratios (RR) and heterogeneity (I2) were calculated using inverse variance random effects models. Results: Ten articles with high-quality results were identified for meta-analysis. Past medical history of stroke or TIA was a predictor of recurrent ischemic stroke (pooled RR 2.5, 95% CI 2.1–3.1). Small vessel strokes were associated with a lower risk of recurrence than large vessel strokes (pooled RR 0.3, 95% CI 0.1–0.7). Patients with stroke of an undetermined cause had a lower risk of recurrence than patients with large artery atherosclerosis (pooled RR 0.5, 95% CI 0.2–1.1). We found no studies using CT or ultrasound for the prediction of recurrent ischemic stroke. The following MRI findings were predictors of recurrent ischemic stroke: multiple lesions (pooled RR 1.7, 95% CI 1.5–2.0), multiple stage lesions (pooled RR 4.1, 95% CI 3.1–5.5), multiple territory lesions (pooled RR 2.9, 95% CI 2.0–4.2), chronic infarcts (pooled RR 1.5, 95% CI 1.2–1.9), and isolated cortical lesions (pooled RR 2.2, 95% CI 1.5–3.2). Conclusions: In patients with a recent ischemic stroke, a history of stroke or TIA and the subtype large artery atherosclerosis are associated with an increased risk of recurrent ischemic stroke. Predictors evaluated with MRI include multiple ischemic changes and isolated cortical lesions. Predictors of recurrent ischemic stroke concerning CT or ultrasound have not been published.

scholarly journals Serum Tumor Necrosis Factor-αand Interferon-γLevels in PediatricMycoplasma pneumoniaePneumonia: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Ying Wang ◽  
Yongsheng Zhang ◽  
Wenting Lu ◽  
Liying Wang
Keyword(s):  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Meta Analysis ◽  
Random Effect ◽  
Diagnostic Methods ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Healthy Children ◽  
Necrosis Factor ◽  
Serum Tumor Necrosis

Background.Mycoplasma pneumoniaepneumonia (MPP) is one of the most common forms of community-acquired pneumonia in children. The objective of this study was to explore potential changes in levels of serum tumor necrosis factor-α(TNF-α) and interferon-γ(IFN-γ) associated with pediatric MPP.Methods. This protocol has been registered (PROSPERO 2017: CRD42017077979). A literature search was performed in October 2017 using PubMed, Embase, the Cochrane Library, and other Chinese medical databases to identify studies. The meta-analysis was performed using Review Manager 5.3 software. Random-effect models were used to estimate mean differences (MDs) and 95% confidence intervals (CIs) of cytokine levels.Results. Twelve studies were included in the meta-analysis, encompassing 2,422 children with MPP and 454 healthy control children. Serum TNF-αlevels were significantly higher in children with MPP compared with healthy children (MD = 22.5, 95% CI = 13.78–31.22,P<0.00001), and there was significant heterogeneity across studies (I2 = 100%,P<0.00001). Subgroup analyses showed no evidence for a difference in serum TNF-αlevels between children with refractory and nonrefractory MPP. Serum IFN-γlevels did not significantly differ in children with MPP compared with healthy children (MD = 4.83, 95% CI = −3.27–12.93,P=0.24).Conclusions. Our meta-analysis showed that serum TNF-αand IFN-γlevels were significantly elevated and unchanged, respectively, in pediatric MPP. Because infection by different pathogens has variable effects on serum TNF-αand IFN-γlevels, the finding could be helpful in developing novel diagnostic methods.

scholarly journals Efficacy and safety of netakimab in patients with psoriatic arthritis: results of the phase III PATERA clinical study

2020 ◽  
Vol 58 (5) ◽  
pp. 480-488
Author(s):  
T. V. Korotaeva ◽  
V. I. Mazurov ◽  
A. M. Lila ◽  
I. Z. Gaydukova ◽  
A. L. Bakulev ◽  
...  
Keyword(s):  
Placebo Group ◽  
Psoriatic Arthritis ◽  
Safety Profile ◽  
Phase Iii ◽  
Inadequate Response ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Acr20 Response ◽  
American College Of Rheumatology ◽  
Blinded Manner

Netakimab (NTK) is a humanized anti-interleukin-17А (IL-17A) monoclonal antibody approved for the treatment of psoriatic arthritis, ankylosing spondylitis, moderate to severe psoriasis. Here, we present the results of the 24-weeks double blind period of the PATERA study.Objective. The objective of the study was to evaluate the efficacy and safety of NTK compared to placebo in patients with psoriatic arthritis (PsA).Patients and methods. 194 patients with active PsA with an inadequate response to previous therapy with nonsteroidal anti-inflammatory drugs, conventional or biologic disease-modifying antirheumatic drugs, were randomized in a 1:1 ratio to receive subcutaneous 120 mg NTK or placebo at weeks 0, 1, 2, 4, 6, 8, 10, 14, 18, 22. At week 16 ACR20 (20% improvement in the American College of Rheumatology response criteria) non-responders in placebo group were reassigned to NTK in a blinded manner. The primary endpoint was the proportion of patients achieved ACR20 response at week 24.Results. 82,5% of patients in the NTK group and 9.3% of patients in the placebo group achieved ACR20 at week 24 with the 95% CI [0,63; 0,84] (p < 0,0001). Skin manifestations and axial disease significantly improved with NTK. The safety profile of NTK was comparable to placebo. The most frequent treatment-related AEs were expected and common for all other IL-17 inhibitors: increased alanine aminotransferase (ALT), infections, lymphopenia.Conclusion. NTK in the dose of 120 mg has superior efficacy over placebo in patients with active psoriatic arthritis. The safety profile is consistent with other IL-17 inhibitors.

Treatment of Dactylitis and Enthesitis in Psoriatic Arthritis with Biologic Agents: A Systematic Review and Metaanalysis

2019 ◽  
Vol 47 (1) ◽  
pp. 59-65 ◽  
Author(s):  
Ahmed Mourad ◽  
Robert Gniadecki
Keyword(s):  
Psoriatic Arthritis ◽  
Health Assessment ◽  
Pooled Analysis ◽  
Biologic Agents ◽  
Acr20 Response ◽  
American College Of Rheumatology ◽  
Tnf Α ◽  
Life Improvement ◽  
Factor Α

Objective.Biologic agents with different mechanisms of action [inhibitors of tumor necrosis factor-α (TNF-α), interleukin (IL)-12/23, and IL-17] showed efficacy in randomized controlled trials (RCT) in the treatment of psoriatic arthritis. We conducted a pooled metaanalysis of these agents for treatment of dactylitis and enthesitis and compared results with the American College of Rheumatology 20 (ACR20) response and Health Assessment Questionnaire–Disability Index (HAQ-DI) scores.Methods.A systematic literature search was performed and a pooled metaanalysis of RCT with anti-TNF-α (infliximab, golimumab, adalimumab), anti–IL-12/23 (ustekinumab), and anti–IL-17 (secu kinumab, ixekizumab) was conducted using the random-effects model. Bias was assessed using the Cochrane risk-of-bias tool.Results.Eighteen RCT were included in the pooled analysis (n = 6981). Both TNF-α inhibitors and novel biologics (ustekinumab, secukinumab, ixekizumab) demonstrated significant resolution of dactylitis at Week 24 with pooled risk ratios (RR) versus placebo of 2.57 (95% CI 1.36–4.84) and 1.88 (95% CI 1.33–2.65), respectively. For resolution of enthesitis at Week 24, RR for TNF-α inhibitors was 1.93 (95% CI 1.33–2.79) versus 1.95 (95% CI 1.60–2.38) for novel biologics. Both biologic categories showed overlapping ranges of ACR20 responses (TNF-α inhibitors: RR = 2.23, 95% CI 1.60–3.11; pooled IL-12/23 and −17: RR = 2.30, 95% CI 1.94–2.72) and similar quality of life improvement scores with mean HAQ-DI score changes of −0.29 (95% CI −0.39 to −0.19) and −0.26 (95% CI −0.31 to −0.22), respectively.Conclusion.The pooled analysis demonstrated that anti–TNF-α agents have the same efficacy as novel agents (ustekinumab, secukinumab, and ixekizumab) in dactylitis and enthesitis.

scholarly journals Efficacy and safety of iguratimod combined with methotrexate vs. methotrexate alone in rheumatoid arthritis

2020 ◽  
Author(s):  
L.-J. Chen ◽  
Y.-J. Zhou ◽  
Z.-H. Wen ◽  
F. Tian ◽  
J.-Y. Li
Keyword(s):  
Rheumatoid Arthritis ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Combined Treatment ◽  
Cochrane Collaboration ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
American College Of Rheumatology ◽  
The Cochrane Collaboration

AbstractThe current systematic review and meta-analysis aims to evaluate the efficacy and safety of iguratimod (IGU) combined with methotrexate (MTX) versus MTX alone in rheumatoid arthritis (RA). Two independent investigators searched for original randomized controlled trials (RCTs) related to the combination of IGU and MTX in RA published before November 1, 2019, in PubMed, Cochrane Library, Embase, the China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), and WanFang Data. Additionally, we searched clinical trial registry websites. We assessed the methodological quality of the included trials using the Cochrane Collaboration tool and the seven-point Jadad scale. Statistical analyses were performed using Review Manager (RevMan) 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Meta-regression and publication bias analyses were performed using Stata version 14 software (StataCorp., College Station, TX, USA). A total of 7 RCTs consisting of 665 participants, with 368 participants in the active arm and 297 in the placebo arm, were included in the meta-analysis. The American College of Rheumatology (ACR) value was better in the IGU + MTX group than in the MTX alone group, with a pooled relative risk (RR) for ACR20 (American College of Rheumatology 20% improvement criteria), ACR50, and ACR70 of 1.40 (95% CI, 1.13–1.74), 2.09 (95% CI, 1.67–2.61), and 2.24 (95% CI, 1.53–3.28), respectively. The results of the meta-analysis demonstrated that there was no statistical significance in adverse events (1.06 (95% CI, 0.92–1.23)). The combined treatment is an effective, safe, and economical treatment option for patients who do not respond well to methotrexate alone or for patients who cannot afford expensive biologics that have no confirmed efficacy.

Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis

2017 ◽  
Vol 77 (1) ◽  
pp. 98-103 ◽  
Author(s):  
Claire Rempenault ◽  
Bernard Combe ◽  
Thomas Barnetche ◽  
Cécile Gaujoux-Viala ◽  
Cédric Lukas ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Diseases ◽  
Meta Analysis ◽  
Survival Rates ◽  
Cochrane Library ◽  
Diabetes Incidence ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Mean Differences ◽  
High Density Cholesterol

ObjectiveCardiovascular disease (CVD) is the leading cause of mortality in patients with rheumatoid arthritis (RA). Hydroxychloroquine (HCQ) has been shown to improve survival rates in other inflammatory diseases. We aimed to assess the available literature on the cardiovascular impact of HCQ in patients with RA.MethodsWe systematically searched for studies evaluating the effects of HCQ on cardiovascular outcomes of known risk factors for CVD in patients with RA. Databases searched were MEDLINE (via PubMed), EMBase, Cochrane Library and the American College of Rheumatology and European League Against Rheumatism annual meetings. A meta-analysis was performed with a random-effects model, estimating mean differences (MDs), HRs and 95% CIs. Data were extracted by one investigator and independently checked by another.ResultsThe literature search revealed 185 articles and abstracts of interest; further examination resulted in 16 studies fulfilling the criteria. The MDs between HCQ users and non-users in levels of total, low-density and high-density cholesterol and triglycerides were −9.8 (95% CI −14.0 to −5.6), −10.6 (95% CI −14.2 to −7.0), +4.1 (95% CI 2.2 to 6.0) and −19.2 (95% CI −27.2 to −11.1), respectively. Diabetes incidence was lower for HCQ ever users than never users (HR 0.59 (95% CI 0.49 to 0.70)). HCQ seemed to decrease insulin resistance and incidence of CVD, but data were too few for meta-analysis.ConclusionBesides its limited efficacy for disease activity and progression, HCQ may benefit the metabolic profile and to a lesser extent cardiovascular events in patients with RA, which suggests its usefulness combined with other conventional synthetic disease-modifying antirheumatic drugs.

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